Zero-inflated models for regression analysis of count data: a study of growth and development.

Poisson regression is widely used in medical studies, and can be extended to negative binomial regression to allow for heterogeneity. When there is an excess number of zero counts, a useful approach is to used a mixture model with a proportion P of subjects not at risk, and a proportion of 1--P at-risk subjects who take on outcome values following a Poisson or negative binomial distribution. Covariate effects can be incorporated into both components of the models. In child assessment, fine motor development is often measured by test items that involve a process of imitation and a process of fine motor exercise. One such developmental milestone is 'building a tower of cubes'. This study analyses the impact of foetal growth and postnatal somatic growth on this milestone, operationalized as the number of cubes and measured around the age of 22 months. It is shown that the two aspects of early growth may have different implications for imitation and fine motor dexterity. The usual approach of recording and analysing the milestone as a binary outcome, such as whether the child can build a tower of three cubes, may leave out important information.